How Behavioral Health Organizations Can Meet the Increased Level of External Accountability Requirements
By David Lloyd
Includes CD-ROM with sample administrative, human resource, intake and medical records forms.
David Lloyd, public health’s best known and most successful management guru who specializes in strategies for behavioral health quality improvement and executive decision-making. His bestseller, How to Deliver Accountable Care, gives you the operational, management, and service delivery knowledge and tools you need to provide more consumer-centered, cost-effective, accessible and quality outcome-based services that meet internal and external accountability requirements. You’ll learn how to overcome barriers such as staff resistance, staff feeling lack of empowerment, established “fiefdoms”or “tribes” and vertical accountability sub-organizational culture.
The book provides system designs and implementation strategies to facilitate:
Implementation of the data driven decision-making at the management team and direct care/line staff levels.
Reduction of client no-shows.
Reduction of paperwork and documentation.
Implementation of appropriate clinical “best practice” standards to minimize over- utilization of services for current caseload members.
Better tracking of billable hours
Enhancement of public image to facilitate marketing surplus service capacity to alternative funding sources.
THE RULES HAVE CHANGED!
The Four Cornerstones
The CBHO Best Value Mission
How Many People are Tired of Talking About Changing?
How Does the Change Initiative Get Out of the Station?
Does This Sound Familiar?
REALITY BASED CHALLENGES
Requirement to Shift from Supervisor to Manager to Leader
Implementing Solutions to Internal CBHO Challenges
Utilizing Proactive Management Principles
Quantifying Work Responsibilities/Work Flow
Separating Authority from Responsibility
Moving Beyond Oral Traditions, Policies, and Standards
TRIBES WITHIN THE SERVICE DELIVERY SYSTEM
What Tribes of Care Look Like
Standardized Screening and Triage Facilitates Internal and External Integration
Internal Utilization Management Requirements to Enhance Service Capacity
Fair and Equitable Requirements
HORIZONTAL ACCOUNTABILITY — AN INTERNAL CUSTOMER SERVICE AND ACCOUNTABILITY RESPONSE
Need to Move From Supervisor to Manager Focus
Role of Unit and Middle Managers
Management Standards to Ensure Compliance
Staff Awareness Assessment
Awareness and Accountability Assessment For Clinical and Non-Clinical Staff
What Has Changed?
Full Circle of Accountability
Internal Customer Service — An Integrated Management Requirement
Horizontal Accountability/Recommended Organizational Structure
Horizontal Accountability and the Shift from Supervisor to Manager
The Train That Will Drive the Change
Training and Mentoring Program
DATA DRIVEN DECISION-MAKING — A MUST!
No or Distrusted Performance Data Leads to Process-Based Indecision Culture
A Solution to Process Based Discussions
Data Driven Staff Acceptance
Five Level Staff and Managers Acceptance Process
Action One — Clinical and Non-Clinical Staff Performance Standards
Decision-Making Process and Values
Assess Need for Meetings
Measurement to Support Decision-Making Meeting Needs
“DON’T YOU OWN A COPY MACHINE?
Paperwork, the Top Frustration
Multi-Layered Gates Drive Paperwork
Two Intake/Admission Gate Process
Intake/Admission Gate Reduction Outcomes
Multiple-Admission Gates Exacerbate “No Shows”
Integrated Assessment and Individualized Service Planning Models
Case Coordination/Comprehensive Plan Development
Addressing Multi-Layered Paperwork Requirements
The Standardized Documentation Solution
Standardized Documentation Outcomes !
THE REALITY OF PAPERWORK BURN OUT AND NON-COMPLIANCE
Delayed Documentation Model
Narrative Documentation Vs. Structured Documentation
Complying with Medical Necessity Linkages Requirements
Purpose of Assessment in Medical Necessity Linkage Requirements
Purpose of Intake/Assessment Updates In Medical Necessity Linkage Requirements
Purpose of Individualized Service/Recovery Plan In Medical Necessity Linkage
Purpose of Individualized Service/Recovery Plan Addendum In Medical Necessity Linkage
Purpose of Structured Progress Notes In Medical Necessity Linkage Requirements
Medical Necessity Linkage Training Handouts
Sample Assessment Update Form
Individualized Service/Recovery Plan Addendum
Combination Progress Notes and Event Tickets/SALs
Progress Notes at the Time of Service
Daily Submission Standard Outcomes
Recommended Closed Audit Loop At End of Service Submission Standard
Daily Submission Standards
Dictation Vs. Handwritten Vs. Electronic Record Keeping
Low Accountability to Accountable Care Comparison
ACCOUNTABLE CARE — COST EFFECTIVE CHANGE
Service Capacity vs. Over-Utilization
The Calculus of Healthcare
Actual Minute Billable Hours vs. Rounded-up Units of Care
Recommended Stages of Service Capacity Billable Hour Standards
Service Capacity Billable Hour/Service Unit Standard
CBHO Service Capacity Billable Hour Standard Breakdown
Identified Barriers to Meeting Billable Hour/Service Unit Standards
Supervision Log/Performance Improvement Action Plans
Individual Supervision Log
Performance Based Contracting
Administrative Management Team Monthly Monitoring Measures
Area Management Team Monthly Monitoring Measures
Accountable Care Enhancement Incentive Pay Plans
Proposed Compensation Plans for Adult Services
Cost Effective Change Conclusions
A New Consumer Relations Focus
SERVING THE SYSTEM OR SERVING THE CONSUMER?
CBHO Consumer Service Focus Summary
A “We Can Do This” Focus
“Change Personality” Types Summary
Change Personality Barrier Indicators
Important Internal Staff Values
Serving the System or Serving the Consumer, Revisited
Recommended “No-Show” Solutions
Internal Customer Services
EXTERNAL COMMUNITY RELATIONS/MARKETING INITIATIVES
Public Image is Important
Community Relations and Image Building Plan Models
Media Guide Advantages
News Release Development
Who Is Going to Do It?
FACILITATING EMPOWERED ACCOUNTABLE CARE CHANGE
Developing a Project Management Plan
SOQIC Project Organizational Chart
Recommended Timeline for SOQIC Reengineering Project
Role and Responsibilities
CFAST Steering Team Protocols
SOQIC Goals and Objectives
Project Management Plan Outcomes
Team Meeting Schedule
Team Membership Nomination Recommendations
Transition Plan for Current Initiatives
Project Management Software
Project Team Participation Guide
Project Team Participation and Meeting Guidelines
SOQIC Project Team Meeting Evaluation
Focus Areas for Measurement of Cost Efficiency Levels
Overall Program Evaluation
Project Management Structure for Empowerment Change
Action Plan for Project Work Teams
Scope of Work Integration Need for Each Team
Holding the Course
Evaluate Compliance, Fairness and Equitability of Change Initiatives
MOVEMENT TO MORE ACCOUNTABLE CARE OUTCOMES
The Center for Mental Health, Inc.
Crossroads Behavioral Healthcare
East Alabama Mental Health-Mental Retardation Center
Georgia Highlands Center
Guilford County Area MH/DD/SA Program
Hill Country Community MHMR Center
Nova Behavioral Health, Inc.
West Michigan Community Mental Health System